title: Access to improved water and its relationship with diarrhoea in Kathmandu Valley, Nepal: a cross-sectional study.
abstract: OBJECTIVE
  To assess the associations between diarrhoea and types of water sources, total quantity of water consumed and the quantity of improved water consumed in rapidly growing, highly populated urban areas in developing countries.
  
  
  METHODS
  Cross-sectional analysis using population-representative secondary data obtained from an interview survey conducted by the Asian Development Bank for the 2009 Kathmandu Valley Water Distribution, Sewerage and Urban Development Project.
  
  
  METHODS
  Kathmandu Valley, Nepal.
  
  
  METHODS
  2282 households.
  
  
  METHODS
  A structured questionnaire was used to collect information from households on the quantity and sources of water consumed; health, socioeconomic and demographic status of households; drinking water treatment practices and toilet facilities.
  
  
  RESULTS
  Family members of 179 households (7.8%) reported having developed diarrhoea during the previous month. For households in which family members consumed less than 100 L of water per capita per day (L/c/d), which is the minimum quantity recommended by WHO, the risk of contracting diarrhoea doubled (1.56-fold to 2.92-fold). In households that used alternative water sources (such as wells, stone spouts and springs) in addition to improved water (provided by a water management authority), the likelihood of contracting diarrhoea was 1.81-fold higher (95% CI 1.00 to 3.29) than in those that used only improved water. However, access to an improved water source was not associated with a lower risk of developing diarrhoea if optimal quantities of water were not consumed (ie, <100 L/c/d). These results were independent of socioeconomic and demographic variables, daily drinking water treatment practices, toilet facilities and residential areas.
  
  
  CONCLUSIONS
  Providing access to a sufficient quantity of water-regardless of the source-may be more important in preventing diarrhoea than supplying a limited quantity of improved water.
authors.affiliation: Interdisciplinary Graduate School of Medicine and Engineering, The University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Salina
authors.initials: S
authors.lastname: Shrestha
authors.forename: Yoko
authors.initials: Y
authors.lastname: Aihara
authors.forename: Kanako
authors.initials: K
authors.lastname: Yoden
authors.forename: Zentaro
authors.initials: Z
authors.lastname: Yamagata
authors.forename: Kei
authors.initials: K
authors.lastname: Nishida
authors.forename: Naoki
authors.initials: N
authors.lastname: Kondo
keywords: Developing Countries; Diarrhoeal Disease; Nepal; Social Inequalities; Urbanisation; Water Supply